Abstract 4343454: Initial Total Correction vs. Staged Repair in Neonatal TOF: Nationwide Evidence on Multi-Organ Outcomes

Background: While early surgical repair in tetralogy of Fallot (TOF) is increasingly favored, the long-term impact of surgical strategy—particularly on extracardiac organs—remains unclear. This study aimed to compare neurologic, pulmonary, renal, hepatic, and developmental outcomes between initial total correction and staged repair in neonates with TOF. Methods: We analyzed data from the Korean National Health Insurance Service database (2005–2021), including all infants diagnosed with TOF within the first year of life. Patients were grouped by surgical strategy: (1) initial total correction within 30 days of diagnosis and (2) staged repair, defined as PDA stent or shunt followed by total correction. Primary outcomes were extracardiac complications identified by ICD-10 codes. Multivariable Cox regression models were used to estimate adjusted hazard ratios (HRs), with subgroup analyses for patients undergoing intervention within 1 and 3 months of diagnosis. Results: Among 2,496 patients who underwent total correction, the staged repair group had significantly higher risks of neurologic (HR 6.08; 95% CI, 3.43–10.78), renal (HR 9.95; 95% CI, 4.79–20.66), and developmental (HR 1.70; 95% CI, 1.42–2.03) complications compared to the initial correction group. These associations persisted across early intervention subgroups. Pulmonary and hepatic complications showed no significant difference. Independent predictors of adverse outcomes included low birth weight and presence of genetic disorders. Conclusions: In this nationwide study, staged repair in TOF was associated with substantially greater long-term risk of renal, neurologic, and developmental complications, even in infants requiring early intervention. These findings support consideration of extracardiac morbidity—not just cardiac survival—when selecting surgical timing in TOF.